title: Variceal band ligation in the prevention of variceal bleeding: a multicenter trial.
abstract: OBJECTIVE
  Variceal bleeding is a life-threatening complication of portal hypertension with a high probability of recurrence. Treatment to prevent first bleeding or rebleeding is mandatory. The study has been aimed at investigating the effectiveness of endoscopic band ligation in preventing upper gastrointestinal bleeding in patients with portal hypertension and to establish the clinical outcome of patients.
  
  
  METHODS
  We analyzed in a multicenter trial, the efficacy and side effects of endoscopic band ligation for the primary and secondary prophylaxis of esophageal variceal bleeding. We assigned 603 patients with portal hypertension who were hospitalized to receive treatment with endoscopic ligation. Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The primary end point was recurrent bleeding.
  
  
  RESULTS
  The median follow-up period was 32 months. A total of 126 patients had recurrent bleeding. All episodes were related to portal hypertension and 79 to recurrent variceal bleeding. There were major complications in 51 patients (30 had bleeding esophageal ulcers). Seventy-eight patients died, 26 deaths were related to variceal bleeding and 1 to bleeding esophageal ulcers.
  
  
  CONCLUSIONS
  A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.
authors.affiliation: Department of Gastroenterology, Habib Thameur Hospital, Tunis, Tunisia. asma.kchaou@voila.fr
authors.forename: Asma
authors.initials: A
authors.lastname: Ouakaa-Kchaou
authors.forename: Jamel
authors.initials: J
authors.lastname: Kharrat
authors.forename: Khaoula
authors.initials: K
authors.lastname: Mir
authors.forename: Boussourra
authors.initials: B
authors.lastname: Houda
authors.forename: Nabil
authors.initials: N
authors.lastname: Abdelli
authors.forename: Salem
authors.initials: S
authors.lastname: Ajmi
authors.forename: Msaddek
authors.initials: M
authors.lastname: Azzouz
authors.forename: Hatem
authors.initials: H
authors.lastname: Ben Abdallah
authors.forename: Nabyl
authors.initials: N
authors.lastname: Ben Mami
authors.forename: Slim
authors.initials: S
authors.lastname: Bouzaidi
authors.forename: Sofiene
authors.initials: S
authors.lastname: Chouaib
authors.forename: Lamia
authors.initials: L
authors.lastname: Golli
authors.forename: Wissem
authors.initials: W
authors.lastname: Melki
authors.forename: Taoufik
authors.initials: T
authors.lastname: Najjar
authors.forename: Hammouda
authors.initials: H
authors.lastname: Saffar
authors.forename: Najet
authors.initials: N
authors.lastname: Belhadj
authors.forename: Abdeljabbar
authors.initials: A
authors.lastname: Ghorbel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016558:Hemostasis, Endoscopic; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000628:therapy; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy; D016896:Treatment Outcome; D055815:Young Adult